Vivid Med Spa, Professional Corporation

Primary specialty

Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X

Legal business name

VIVID MED SPA, PROFESSIONAL CORPORATION

Practice address

166 E Gobbi St
Ukiah, CA 95482-4918

Phone

(707) 414-0419

NPI assigned

Mar 9, 2026

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Ria Prakash Jivan, RN

Title

Ceo

Phone

(903) 363-5914

Specialties & licenses 5

Addresses

Other names 1

• Vivid Med Spa & Laser Clinic Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1773014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773014400000",
    "number": "1619823036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "166 E GOBBI ST",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954824918",
            "telephone_number": "707-414-0419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 E GOBBI ST",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954824918",
            "telephone_number": "707-414-0419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIVID MED SPA, PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-03-09",
        "last_updated": "2026-03-09",
        "certification_date": "2026-03-08",
        "status": "A",
        "authorized_official_last_name": "JIVAN",
        "authorized_official_first_name": "RIA",
        "authorized_official_middle_name": "PRAKASH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "903-363-5914",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vivid Med Spa & Laser Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Keith Vidra
• Louie Vigil
• Aeolian Vincent-Depaule, B.S.
• Isabel Vineyard
• Renee Vinyard, PA
• Anthoula S Vlachos, DDS
• Dieu Linh Thi Vo, PHARMD
• Dana Vogele
• Ruthanne Volz
• Whitney S Vonfeldt

• Infusion Therapy Clinic/Center in Ukiah, CA
• Providers in Ukiah, CA by specialty
• Infusion Therapy Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.